Antidepressants 1

Question 1

What is the hypothesis of mood?

Answer 1

Major depressive disorders result from a functional deficiency of NE, 5-HT, and dopamine at synapses in the CNS

Question 2

What 3 neurotransmitter defiiencies is thought to cause major depressive disorders?

Answer 2

NE

5-HT

Dopamine

Question 3

T/F: All classes of antidepressants appear to enhance the synaptic availability of 5-HT, norepinephrine, or dopamine

Answer 3

TRUE

Question 4

T/F: Attempts to develop antidepressants that work on other neurotransmitter systems have been effective to date.

Answer 4

FALSE

Attempts to develop antidepressants that work on other neurotransmitter systems have NOT been effective to date.

Question 5

Changes in what 2 components appear to play a major role in the development of major depression?

Answer 5

BDNF

hormones

Question 6

What is considered successful tx of depression?

Answer 6

a change in BDNF and hormones

Question 7

NTs carry ______ between cells.

Answer 7

messages

Question 8

These bind to a specific receptor, and this coupling initiates a cascade of events.

Answer 8

NTs

Question 9

These are reabsorbed back ininto nerve cells by reuptake pumps (transporter molecules) at which point they may be recycled for later use or broken down by enzymes

Answer 9

NTs

Question 10

MOA for which drugs?

inhibit the transporter molecules and allow more NT to remain in the synapse

Answer 10

antidepressants

Question 11

Which dz?

associated with changes in serotonin or norepinephrine signaling in the brain (or both) with significant downstream effects (lesser-dopamine)

Answer 11

Depression

Question 12

Most antidepressants cause changes in _____ signaling.

Answer 12

Most antidepressants cause changes in amine signaling.

Question 13

What neuroendocrine factors are associated with more severe forms of depression?

Answer 13

Abnormal HPA axis

Elevated cortisol levels

Thyroid dysregulation

Estrogen/testosterone deficiency

Trytophan deficient diet

Question 14

How do elevated cortisol levels contribute to major depression?

Answer 14

lead to dysregulation of the stress hormone axis

Question 15

Why would a tryptophan deficient diet cause major depression?

Answer 15

tryptophan is a precursor of serotonin synthesis

Question 16

What are the 3 phases of tx in MDD?

Answer 16

acute phase

continuation phase

maintenance phase

Question 17

lasts 6 to 12 wks in which the goal is remission (absence of symptoms)

Which phase of MDD tx?

Answer 17

acute

Question 18

lasts 4 to 9 mos after remission is achieved, in which the goal is to eliminate residual symptoms or prevent relapse (ie, return of symptoms within 6 months of remission)

Which phase of MDD is this?

Answer 18

Continuation Phase

Question 19

lasts at least 12 to 36 mos in which the goal is to prevent recurrence (a separate episode of depression)

Which phase of MDD is this?

Answer 19

Maintenance Phase

Question 20

Which acne tx is associated with drug-induced depressive sx?

Answer 20

isotretinoin

Question 21

Which anticonvulsants are associated with drug-incuced depressive sx?

Answer 21

Levetiracetam

Topiramate

Vigabatrin

“Leave it To Viagara”

Question 22

Which antimigraine tx is associated with drug-induced depressive sx?

Answer 22

triptans

Question 23

Which CV tx are associated with drug-induced depressive sx?

Answer 23

Beta blocker

Clonidine

Methyldopa

reserpine

“The beta fish cloni takes meth with the serpent”

Question 24

Which hormonal therapies are associated with drug-induced depressive sx?

Answer 24

Gonadotropin-releasing hormone

Oral contraceptives

Steroids (prednisone)

Tamoxifen

Question 25

Which **immunologic agents** are associated with drug-induced depressive sx?

Answer 25

Interferons

Question 26

Which **smoking cessation drug** is associated with drug-induced depressive sx?

Answer 26

Varenicline

Question 27

What are the 6 antidepressant pharmacotherapy options?

Answer 27

**Tricyclic** antidepressants **MAO** inhibitors **SSRIs** **SNRIs** (5-HT-NE) **5-HT₂** **Heterocyclic** antidepressants

Question 28

The hypothesis that major depressive disorders result from a **functional deficiency of norepinephrine or serotonin** at synapses in the CNS Which hypothesis?

Answer 28

Amine hypothesis of mood

Question 29

Structurally related drugs that block reuptake transporters of both **norepinephrine (NE) and serotonin (5-HT)** Which drug?

Answer 29

tricyclic

Question 30

Drugs that selectively **inhibit serotonin (5-HT) transporters** with only modest effects on other neurotransmitters Which drug?

Answer 30

SSRIs

Question 31

**Heterocyclic drugs** that block **NE and 5-HT transporters**, but **lack the alpha blocking, anticholinergic and antihistaminic actions of TCAs** Which drug?

Answer 31

SNRIs

Question 32

Structurally related drugs that **block this subgroup of serotonin receptors with only minor effects on amine transporters**

Answer 32

5-HT2 receptor antagonists

Question 33

Term used for antidepressants of varying chemical structures, the characteristics of which do not strictly conform to any specific designations

Answer 33

Heterocyclics

Question 34

What are the 4 PK of antidepressants?

Answer 34

Fairly **rapid oral absorption** Achieve peak plasma levels within 2-3 hours **Tightly bound to plasma proteins** Undergoes **hepatic metabolism** **Renally cleared**

Question 35

What are the 5 main antidepressant indications?

Answer 35

Major depressive disorder (MDD) Panic disorder Generalized anxiety disorder (GAD) Post traumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD)

Question 36

Other A-depressant indications

Answer 36

Neuropathic pain Pain associated with fibromyalgia Premenstrual dysphoric disorder (PMDD) Mitigates vasomotor symptoms of menopause Stress incontinence

Question 37

What 6 conditions would you use TCAs for?

Answer 37

MDD (backup) chronic pain OCD Pain conditions Enuresis (urinary inconintence) insomnia

Question 38

What are the names of the 4 tricyclic antidepressants?

Answer 38

imi**pramine** desi**pramine** doxepin nortriptyline

Question 39

What TCA would you use for OCD?

Answer 39

clomipramine

Question 40

Toxicities of which drug? **α block** **Muscarinic block** sedation, weight gain **Overdose:** arrhythmias, seizures

Answer 40

TCAs

Question 41

Drug interaction if you take **TCAs with ethanol or sedative hypnotics?**

Answer 41

increased CNS depression

Question 42

Drugs inhibiting monoamine oxidases that metabolize norepinephrine and serotonin (MAO type A) and dopamine (MAO type B) Which drug?

Answer 42

MAOI

Question 43

What are the 4 indications for MAOI?

Answer 43

**MDD** unresponsive to other agents **Anxiety** **panic disorder** **Selegiline-Parkinson’s disease**: Amphetamine-like metabolites

Question 44

What are the 3 MAOIs we should know?

Answer 44

**Phenelzine** **Tranylcypromine** **Selegiline**

Question 45

Which MAOI is more active against MAO-B?

Answer 45

selegiline

Question 46

What is the clinical application for MAOIs?

Answer 46

Major depression unresponsive to other drugs

Question 47

PK & drug interactions of which drug? **HTN with tyramine** and **sympathomimetics** **Serotonin syndrome** with SSRIs **_Very long half-lives_**

Answer 47

MAOI

Question 48

What are the toxicities of MAOIs?

Answer 48

Hypotension insomnia

Question 49

What foods should pts taking MAOIs avoid?

Answer 49

anything with tyramine content: dairy products alcohol canned meats yeast products chocolate coffee